Coronavirus Tidbits #186 4/3/22

April 3, 2022 /

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Announcements:

First, there is now a Resources Page here for the most commonly asked questions I'm getting.

Happy to continue to answer your questions/concerns as best I can, so don't be shy about that.

New posts:

Blood Collection Tube Shortages Continue - “Routine” Labs Should Be Limited

https://www.forbes.com/sites/judystone/2022/03/28/blood-collection-tube-shortages-continueroutine-labs-should-be-limited/

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Can Higher Dose Primaquine Shorten Malaria Treatment?

https://www.medscape.com/viewarticle/971313

News: 

Heart problems much more likely with COVID infection than vaccine

Myocarditis or pericarditis are much more likely to follow infection with SARS-CoV2 compared with COVID-19 vaccinations, according to research published today in Morbidity and Mortality Weekly Report.

The study was based on electronic health records from 40 US health care systems from Jan 1, 2021, through Jan 31, 2022, and heart conditions following COVID-19 infections among stratified age groups (5 to 11, 12 to 17, 18 to 29, and ≥30 years). The rates were compared to documented cases of cardiac conditions following one or two doses of mRNA vaccines.

Myocarditis is inflammation of the heart muscle, and pericarditis is inflammation of the tissue that encases the heart.

Data support vaccination

"The incidence of cardiac outcomes after mRNA COVID-19 vaccination was highest for males aged 12–17 years after the second vaccine dose; however, within this demographic group, the risk for cardiac outcomes was 1.8–5.6 times as high after SARS-CoV-2 infection than after the second vaccine dose," the authors wrote.

For boys ages 5 to 11, the incidences of myocarditis and myocarditis or pericarditis were 12.6 to 17.6 cases per 100,000 after infection, 0 to 4 cases after the first vaccine dose, and 0 after the second dose.

The numbers shift substantially for males ages 12 to 17: In that group, the incidences of myocarditis and myocarditis or pericarditis were 50.1 to 64.9 cases per 100,000 after infection, 2.2 to 3.3 cases after the first vaccine dose, and 22.0 to 35.9 after the second dose.

Though cardiac complications following either natural infection or vaccination were rare, they were much more common in males compared to females, and in teens compared to older adults or younger children. The authors say the findings support the continued use of mRNA vaccinations.

https://www.cidrap.umn.edu/news-perspective/2022/04/heart-problems-much-more-likely-covid-infection-vaccine

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Research: Symptoms don't correlate with viral shedding

Today new research from a human challenge study out of Imperial College London shows COVID-19 symptoms don't correlate with viral shedding. Study results are published today in Nature Medicine. ( press release.)

This is the first and only human challenge trial studying COVID-19 transmission, and included 36 healthy young adults ages 18 to 30 who were exposed to the virus.

Eighteen participants in the trial caught COVID-19, but symptom severity— and even the absence of symptoms — did not correlate with how much virus each participant shed during the study.

Most participants who contracted the virus did so within 2 days of exposure, and viral shedding was highest on day 5. By that day, the virus was found most abundantly in the nose.

All of the study participants who contracted COVID-19 recovered from mild illness.

Currently 1 in 13 people in the United Kingdom have COVID-19, the highest prevalence rate seen during the 2-year pandemic.

https://www.cidrap.umn.edu/news-perspective/2022/04/heart-problems-much-more-likely-covid-infection-vaccine

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Breakthrough infections

Epic researchers used medical records to find pregnant women are 1.91 times as likely to have a breakthrough infection.

And individuals with a solid organ transplant are 1.83 times as likely, and people with an immune system deficiency are 1.63 times as possible.

https://www.precisionvaccinations.com/2022/04/01/covid-19-vaccinated-pregnant-women-found-high-risk-breakthrough-infection

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Different variants produce varied long COVID symptoms, study suggests

Pre–Delta variant data to be presented next month at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) meeting in Portugal suggest that different variants of COVID-19 may produce different symptoms in people who develop long COVID.

The research is based on outcomes seen in 428 COVID-19 case-patients at the University of Florence and Careggi University Hospital in Italy. The patients were seen from June 2020 to July 2021, when the Alpha variant was the dominant strain and before the Delta and Omicron variants rose to prominence.

Seventy-six percent of the patients reported at least one persistent symptom of COVID-19 during follow-up, including shortness of breath (37%) and chronic fatigue (36%) followed by sleep problems (16%), vision problems (13%), and brain fog (13%).

Compared to men, women were twice as likely to develop long COVID, and patients on immunosuppressive drugs were six times more likely.

The authors also found a change in long COVID symptoms when comparing patients who had Alpha variant to those infected with the original, wild-type strain. Myalgia, insomnia, brain fog and anxiety and depression significantly increased with the Alpha strain, while anosmia (loss of smell), dysgeusia (difficulty in swallowing), and impaired hearing were less common.

"This is the first time they [symptoms] have been linked to different COVID-19 variants," said Michele Spinicci, MD, the lead researcher of the study, in an ECCMID press release. "Future research should focus on the potential impacts of variants of concern and vaccination status on ongoing symptoms."
Mar 24 ECCMID press release

https://www.cidrap.umn.edu/news-perspective/2022/03/covid-19-scan-mar-25-2022

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Study shows COVID-19's lingering impacts on the brain

COVID-19 patients commonly report having headaches, confusion and other neurological symptoms, but doctors don't fully understand how the disease targets the brain during infection.

Now, researchers at Tulane University have shown in detail how COVID-19 affects the central nervous system, according to a new study published in Nature Communications.

The findings are the first comprehensive assessment of neuropathology associated with SARS-CoV-2 infection in a nonhuman primate model.

The team of researchers found severe brain inflammation and injury consistent with reduced blood flow or oxygen to the brain, including neuron damage and death. They also found small bleeds in the brain.

Surprisingly, these findings were present in subjects that did not experience severe respiratory disease from the virus.

https://medicalxpress.com/news/2022-04-covid-lingering-impacts-brain.html

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‘A slow-moving glacier’: NIH’s sluggish and often opaque efforts to study long Covid draw patient, expert ire.

More than 15 months ago, the NIH got over $1 billion to study long Covid. But so far it's brought in just 3% of the patients it plans to.

https://www.statnews.com/2022/03/29/nih-long-covid-sluggish-study/?

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After COVID-19, experts say watch for these potential heart and brain problems

Those heart problems include irregular heartbeats, heart failure (the inability of the heart to pump properly), coronary disease (buildup in arteries that limits blood flow), heart attacks and more.

after one year, those who had COVID-19 were 63% more likely to have some kind of cardiovascular issue, resulting in about 45 additional cases per 1,000 people. (Nature Medicine in February)

The Nature Medicine study also found a 52% increased risk of stroke at one year among COVID-19 survivors, or about four extra strokes per 1,000 people.

a 35% increased risk of anxiety disorders after COVID-19, or 11 additional cases per 1,000 people after one year compared to those without COVID-19. The risk for depression was slightly higher.

https://medicalxpress.com/news/2022-03-covid-experts-potential-heart-brain.html?

Diagnostics:

England ends free virus tests under 'living with COVID' plan

The British government is ending the supply of free rapid coronavirus tests to most of the population even though COVID-19 infections remain at record levels,

https://medicalxpress.com/news/2022-03-england-free-virus-covid.html?

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US no longer paying for testing for uninsured, Medicare, or Medicaid patients.

Thank GOP members of Congress who voted against funding.

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Drugs and Vaccines:

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Mix and Match mRNA Boosters? It May Be a Good Idea, Experts Say

— "You can diversify your immune response as much as possible to get maximal protective immunity"

Moderna appeared to have an advantage in mucosal immunity, as measured by immunoglobulin (Ig) A, while Pfizer had a "really functional IgG response,"

[A question that remains unanswered is if the differences identified may confer differential protection.]

https://www.medpagetoday.com/special-reports/exclusives/97979?

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More Evidence Hybrid Immunity Confers Highest Level of COVID Protection

vaccine effectiveness against symptomatic disease at least 14 days after series completion was 44.0% for Johnson & Johnson's vaccine and 64.8% after two doses of Pfizer's vaccine,

Moreover, vaccine effectiveness against COVID-related hospitalization or death was 57.7% (95% CI -2.6 to 82.5) for Johnson & Johnson's vaccine, and 89.7% (95% CI 54.3-97.7) for Pfizer's, the authors wrote in Lancet Infectious Diseases.

https://www.medpagetoday.com/infectiousdisease/covid19vaccine/97982?

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Early Use of High-Titer Plasma Reduced COVID Hospitalizations

— Randomized trial that influenced indication shows benefits in a mostly unvaccinated population

COVID-19-related hospitalization or death within 28 days occurred in 2.9% of transfusion recipients compared with 6.3% of recipients of control plasma (P=0.005), for a relative 54% risk reduction that was entirely accounted for by hospitalization.

The number needed to treat to prevent one hospitalization was 29.4. The magnitude of effect was on par with that of monoclonal antibodies against SARS-CoV-2 during the Alpha variant wave,

New England Journal of Medicine.

https://www.medpagetoday.com/infectiousdisease/covid19/97954?

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For red and blue America, a glaring divide in COVID-19 death rates persists 2 years later

Post-vaccine, death rates in red states were 38% higher than in blue states.

https://abcnews.go.com/Health/red-blue-america-glaring-divide-covid-19-death/story?id=83649085

Devices and Masks:

What's next with face masks? Keep wearing them in public, wear the best mask available and pay attention to fit

Early in the pandemic, mask-wearing policies were consistently associated with decreased transmission of SARS-CoV-2. At that time, the masks worn were generally made of cloth and often improvised.

We recommend double masking medical masks or using minor modifications or mask hacks that enhance fit and reduce leakage.

Carefully designed, well-fitting, multilayer reusable cloth masks still have an important ongoing role in reducing transmission of SARS-CoV-2, especially in lower risk settings.

Consumer categories that predictably exhibited fitted filtration efficiency comparable with that of a medical mask, acceptable breathability, and suitability for construction of a pleated mask were T-shirt, fashion fabric, mass-market quilting cotton, home décor fabric, bed sheets and high-quality quilting cotton.

2-ply all-cotton masks of recommended consumer-grade materials can provide low-cost, more sustainable alternatives to single-use loose fitting disposable medical masks. Importantly, such masks, over multiple wearings, are more economical for the mask wearer.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0264090

Epidemiology/Infection control:

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Pandemic lockdowns had severe mental health consequences for women in the developing world

While potentially crucial to preventing the spread of COVID-19, lockdowns are associated with increased rates of depression and anxiety as well as food insecurity among women in India and other parts of the developing world, according to a new research.

The study from the University of California San Diego's School of Global Policy and Strategy finds that women whose social position may make them more vulnerable—those with daughters and those living in female-headed households—experienced even larger declines in mental health as a result of lockdowns.

The paper, to be published in a forthcoming issue of the Journal of Economic Development, surveyed 1,545 households over the phone in various rural regions throughout Northern India.

https://medicalxpress.com/news/2022-04-pandemic-lockdowns-severe-mental-health.html

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Mental Health, Suicidality, and Connectedness Among High School Students  January–June 2021

CDC Supplements / April 1, 2022 / 71(3);16–21

Disruptions and consequences related to the COVID-19 pandemic, including school closures, social isolation, family economic hardship, family loss or illness, and reduced access to health care, raise concerns about their effects on the mental health and well-being of youths. This report uses data from the 2021 Adolescent Behaviors and Experiences Survey, an online survey of a probability-based, nationally representative sample of U.S. public- and private-school students in grades 9–12 (N = 7,705), to assess U.S. high school students’ mental health and suicidality during the COVID-19 pandemic. The study also examines whether mental health and suicidality are associated with feeling close to persons at school and being virtually connected to others during the pandemic.

Overall, 37.1% of students experienced poor mental health during the pandemic, and 31.1% experienced poor mental health during the preceding 30 days. In addition, during the 12 months before the survey, 44.2% experienced persistent feelings of sadness or hopelessness, 19.9% had seriously considered attempting suicide, and 9.0% had attempted suicide. Compared with those who did not feel close to persons at school, students who felt close to persons at school had a significantly lower prevalence of poor mental health during the pandemic (28.4% versus 45.2%) and during the past 30 days (23.5% versus 37.8%), persistent feelings of sadness or hopelessness (35.4% versus 52.9%), having seriously considered attempting suicide (14.0% versus 25.6%), and having attempted suicide (5.8% versus 11.9%). The same pattern was observed among students who were virtually connected to others during the pandemic (i.e., with family, friends, or other groups by using a computer, telephone, or other device) versus those who were not.

Comprehensive strategies that improve feelings of connectedness with others in the family, in the community, and at school might foster improved mental health among youths during and after the COVID-19 pandemic.

https://www.cdc.gov/mmwr/volumes/71/su/su7103a3.htm

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Diabetes risk rises after COVID, massive study finds

Even mild SARS-CoV-2 infections can amplify a person’s chance of developing diabetes, especially for those already susceptible to the disease.

Nature Clare Watson 31 March 2022

People who get COVID-19 have a greater risk of developing diabetes up to a year later, even after a mild SARS-CoV-2 infection, compared with those who never had the disease, a massive study1 of almost 200,000 people shows.

The research, published in The Lancet Diabetes & Endocrinology earlier this month, is one of a growing number of studies2 showing that COVID-19 can increase a person’s risk of diabetes, months after infection.

“When this whole pandemic recedes, we’re going to be left with the legacy of this pandemic — a legacy of chronic disease” for which health-care systems are unprepared, says study co-author Ziyad Al-Aly, chief researcher for the Veterans Affairs (VA) St Louis Healthcare System in Missouri.

Risks amplified

Al-Aly and Yan Xie, an epidemiologist also at the VA St Louis Healthcare System, looked at the medical records of more than 180,000 people who had survived for longer than a month after catching COVID-19. They compared these with records from two groups, each of which comprised around four million people without SARS-CoV-2 infection who had used the VA health-care system, either before or during the pandemic. The pair previously used a similar method to show that COVID-19 increases the risk of kidney disease3, heart failure and stroke4.

The latest analysis found that people who had had COVID-19 were about 40% more likely to develop diabetes up to a year later than were veterans in the control groups. That meant that for every 1,000 people studied in each group, roughly 13 more individuals in the COVID-19 group were diagnosed with diabetes. Almost all cases detected were type 2 diabetes, in which the body becomes resistant to or doesn’t produce enough insulin.

https://www.nature.com/articles/d41586-022-00912-y

Tips, general reading for public:

Wear a mask. Ventilate. Get vaxxed. #CovidIsAirborne

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Politics:

Covid

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Poverty/Disparities

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https://twitter.com/KarenPercy1/status/1509343258693931010?s=20&t=mD7tjwqYu3wcdbTaGjN7GQ

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Jan 6/GOP

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LGTBQ

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Women

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Nationalism/Racism

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Feel good du jour:

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Comic relief:

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https://twitter.com/buitengebieden_/status/1508884409394552833?s=20&t=mD7tjwqYu3wcdbTaGjN7GQ

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Perspective/Poem

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Bits of beauty:

 

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